The asthma care plan most Australian GPs draft once and never review — and the spirometry numbers that should trigger it

Asthma is the most common chronic condition in Australian general practice, affecting around 2.7 million people per the ABS. It's also the most under-reviewed care plan in our specialty.

Why annual reviews aren't enough

Asthma is a fluctuating disease. Pollen counts, viral seasons, indoor heating, lifestyle changes — all of these shift control month to month. A care plan reviewed once a year describes a disease state from 11 months ago.

The clinical answer is quarterly reviews tied to symptom changes. The practical blocker is the same as every other care plan: nobody's tracking who's due.

The numbers that should trigger a review

• FEV1 drop of more than 10% from the patient's personal best.
• More than two reliever uses per week without a prior agreed action.
• Any overnight wakening due to symptoms.
• An ED presentation or oral corticosteroid course in the last 12 months.
• Pregnancy onset, or planned pregnancy — control standards shift.

What goes into a good asthma plan

The four-zone written asthma action plan is still the standard (RACGP / Asthma Australia 2024). What changes with digital tooling: the plan lives on the patient's phone, the reliever-use log syncs from their device, and the GP sees the actual usage pattern at the next review — not the patient's recollection of it.

We've found patients consistently underestimate reliever use when self-reporting. Logged usage tells a more accurate story, and that story directs the controller dose.